Successful Aging: Dealing with doctors and ageism

Q: I was recently hospitalized with some mysterious symptoms. As expected, a physician came to my room to discuss my history. The conversation went quite well until he looked at my chart and saw my age ­­— 68. At that moment, his tone and demeanor changed. I felt he saw me as an “old woman.” Given that I live alone, he suggested that my symptoms might be of depression. He was dead wrong. I am a fulfilled and successful businesswoman with a vibrant consulting practice. I was annoyed that I had to defend myself. How can a physician change his perception of me because of my age? Is this ageism? And what can we do about it? P.S., I fortunately was accurately diagnosed and have recovered.

— S.W.

A: The best news is that you recovered. The bad news is that you did not have a good conversation with your physician. Given your doctor’s demeanor changing when he noticed your age and also that you were living alone suggests some stereotyped thinking.

Based on your single yet significant experience, we should not assume all physicians have a negative mindset when it comes to their older patients. Let’s think about why your doctor seemed to jump to conclusions. Perhaps he had just seen two previous patients in their late 60s who were lonely and depressed and assumed you were case number three.

Even if this were true, it’s not a good reason since each individual ages differently. Although older adults often have common conditions, each person still is a case of one.

From a national perspective, we do have a problem. It’s a shortage of board-certified geriatricians. According to a blog by Dr. William Thomas, an internationally recognized expert in geriatric medicine, the U.S. should have one certified geriatrician for every 300 individuals who are 85 and older. In 2013, the ratio was one doctor to 870 older people. In 2012, there were only 7,356 certified geriatricians. We need more than 20,000 to effectively serve the 85-and-older generation. The American Geriatrics Society reports we will need 36,000 geriatricians by 2030.

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Of the 145 medical schools in the U.S,, 11 have geriatric departments. In Britain, every medical school has a department of geriatrics; half of the medical schools in Japan do. Additionally, in more than 75 percent of our medical schools, a geriatric curriculum is elective, not required.

Less than half of U.S. medical students report receiving any training in geriatrics; 25 percent of those who were trained said it was insufficient.

The economics of medical care is a de-motivator. Geriatricians, in general, earn less than $200,000 a year once they establish their practice, while other medical specialists often earn twice that amount. With a $150,000 student loan debt, one might understand the choice for a higher-paid specialty.

Let’s return to the subject of ageism. In 1969, Dr. Robert Butler published a significant article on ageism, which he considered another form of bigotry. He predicted that ageism would parallel racism as the great social issue over the next decade. His prediction was accurate.

To increase our understanding of ageism, we need to look at the subject beyond the medical environment. Research by Susan Fiske, professor of psychology and public affairs at Princeton University, and graduate student Michael North found three areas of what they called “prescriptive prejudice.” Rather than believing what older people are in reality, individuals often perceive what they believe older people should be. The researchers found prescriptive stereotypes center around three issues:

• Succession. People believe that older employees should move aside from high-paying positions to make room for younger folks.

• Identity. This refers to the notion that older people should not attempt to act younger than they are.

• Consumption. This stereotype refers to the belief that older people should not consume scarce resources such as health care.

This research can help us and others do a self-check. What are our assumptions about older people — in the workplace, among our customers, clients and patients, in our families or within our nonprofit organizations?

Ageism is subtle and the only remaining socially acceptable “ism.” While we won’t know the reasons your hospital physician made the assumptions about you, we do know that education and training are powerful tools. One solution to the problem is to increase geriatric education.

We have strength in our community. One example is UCLA Medical Center, which was ranked No. 3 in geriatric medicine among the top 50 hospitals in the U.S.

S.W., thank you for your good question. Hopefully we will have more geriatric education and training, ensuring that competent and compassionate care will be available for each of us.

Send email to Helen Dennis at helendenn@aol.com, or go to www.facebook.com/SuccessfulAgingCommunity.

About the Author

Helen Dennis is nationally recognized leader on issues of aging, employment and retirement with academic, corporate and non profit experience. She has received numerous awards for her university teaching at USC’s Andrus Gerontology Center and for her contributions to the field of aging and the community.
Editor of two books, author of over 50 articles, frequent speaker and weekly columnist on Successful Aging for the Los Angeles Newspaper Group, she has assisted over 10,000 employees to prepare for the non-financial aspects of their retirement. In her volunteer life, she has served as president of five nonprofit organizations. Fully engaged in the field of aging, she was a delegate to the 2005 White House Conference on Aging and is co-author of the Los Angeles Times bestseller, "Project Renewment®: The First Retirement Model for Career Women." Helen has extensive experience with the media including Prime Time, NPR, network news, the Wall Street Journal, Sacramento Bee and Christian Science Monitor.
She recently was the recipient of the excellence in literary arts award from the Torrance Cultural Arts Commission. Reach the author at helendenn@aol.com
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